Healing, Is It Just a Matter of Medication?

Allan Schwartz, LCSW, Ph.D.

"Scientists at the University of Liverpool argue that anti-obesity drugs fail to provide lasting benefits for health and wellbeing because they tackle the biological consequences of obesity, and not the important psychological causes of over consumption and weight gain."

How often have I seen just this type of headline, comment, research result and conclusion? It appears that, in the area of the behavioral sciences, medication alone cannot bring lasting change.

In the case of obesity, researchers in England decided that the reason anti obesity medications fail to bring lasting change is that they do not address the underlying psychological reasons for the weight gain. Even after physiological and nutritional factors are taken into consideration, there is more to weight loss than chemicals.

In my experience and that of many other psychiatrists, psychologists and clinical social workers, addressing underlying psychological dynamics and ways of thinking are necessary to bring real change to peoples' lives.

I have worked with several people who suffered from obesity and found that the driving force that kept the weight on for many of them were sexual and emotional.

While it is often difficult to determine what came first, the excessive weight or depressed feeling, I have no doubt that depression and anxiety are powerful emotional forces in keeping some people obese. Does this seem strange to read?

Keep in mind that excessive weight, for at least some obese people, serves as a defense mechanism against intimacy. Yes, over weight people do have sex and do marry and raise children. At the same time, obesity keeps many other people at a distance. More than one obese woman who consulted me for psychotherapy and reported feeling threatened by uninvited male attention if they were thinner. In a few of these cases there was a history of sexual and physical abuse during childhood.

Feelings of depression, anxiety and panic can be the result of defense mechanisms. This is why many people placed on anti depressants medicines without psychotherapy do not get as good results as those who were in psychotherapy with or without medicines. I clearly remember being taught during my days of training that, yes, you can take symptoms away temporarily but what will you replace them with?

One of the important goals of psychotherapy is to replace symptomatic ways of thinking and behaving with healthy and adaptive ones. It makes no difference whether the therapy is psychodynamic, cognitive, group, family or marital. While medication can help by providing very depressed people with the energy they may not possess to engage in therapy, it is psychotherapy that leads to lasting change.

If you are depressed, obese, anxious or experience any number of the behavioral disorders, do not rely only on medication. Seek psychotherapy, wether of the psychodynamic or cognitive behavioral type.